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The world view of health

08 May 2017

BY AMA PRESIDENT DR MICHAEL GANNON

It was a great privilege to attend the 206th Council Session of the World Medical Association (WMA) in Zambia last month. It was held in the spectacular setting of a hotel on the banks of the Zambezi River, which constitutes the border between Zambia and Zimbabwe before and after its waters thunder over the spectacular Victoria Falls.

The WMA is the peak body representing 111 National Medical Associations (NMAs). As you might imagine, the NMAs are completely disparate in terms of the populations they serve, and no time is devoted to discussing minor industrial matters.

However, the professional matters that influence medical practice and the ethical principles that unite doctors from the six WMA regions are profound.

Substantially, WMA policy is in keeping with AMA policy. The AMA’s strong policy book means we are able to contribute substantially and effectively to the WMA‘s determinations.

Policy documents are worked up through three separate sub-committees before being voted on by the broader Council sessions. They do not become formal WMA policy until endorsed by the General Assembly, which is held once a year. This year’s meeting will be held in Chicago in October.

We discussed at length a whole variety of issues, including:

organ and tissue donation;

boxing;

climate change;

medicinal cannabis;

HIV/AIDS;

hunger strikers;

tuberculosis; and

smallpox destruction.

Some of the WMA’s work remains particularly contentious, including the statement on medical tourism. It is largely accepted that patients should ideally not travel overseas for medical treatment where they might displace local patients, and with follow up mechanisms that are likely to be less than optimal. However, there are numerous examples where it is desirable for patients to travel overseas for health care. In some countries, organ transplantation is not possible.

Issues like these vary across the planet with culture, history, and geography. I live over 2,000 km from the closest city of 100,000 people. Yet my friend and colleague, Dr Andreas Rudkjobing, President of the Danish Medical Association, travels across the Oresund Bridge from near Malmo, Sweden, to Copenhagen to work every day.

One recurring theme at both WMA and AMA meetings, and last year’s meeting of the Confederation of Medical Associations of Asia and Oceania (CMAAO), is the continuing threats to the independence of doctors. I found my conversations with the President of the Turkish Medical Association particularly distressing.

The WMA passed a resolution in support of Dr Serdar Küni, the Human Rights Foundation of Turkey’s representative in Cizre and former President of the Şırnak Medical Chamber, who remains imprisoned after six months of detention on charges that he provided medical treatment to alleged members of Kurdish armed groups.

The case of Dr Küni is one example among many of ongoing arrests, detentions, and dismissals of physicians and other health professionals in Turkey since July 2015, when unrest broke out in the country’s south-east.

The WMA condemns practices that gravely threaten the safety of physicians and the provision of health care services. The protection of health professionals is fundamental, so that they can fulfil their duties to provide care for those in need, without regard to any element of identity, affiliation, or political opinion.

Across the world, doctors face increasing control of their practices by governments, by other regulators, and by their paymasters. In Australia, both government and private health insurers increasingly interfere in the independent practice of medicine.

The WMA’s Declaration of Seoul contends that ‘the central element of professional autonomy and clinical independence is the assurance that individual physicians have the freedom to exercise their professional judgment in the care and treatment of their patients without undue influence by outside parties or individuals’.

I spoke against an editorial revision of this and the Declaration of Madrid, both of which enshrine the independence of doctors as being essential to the inviolability of the doctor-patient relationship, and the need to put the needs of the patient first.

I look forward to my continuing engagement with the WMA. The Declaration of Geneva is currently being subjected to editorial review. I encourage all of you to consider its wise words and let them influence your practice day on day. There are principles and policies on show at the WMA that invoke 2,500 years of medical ethics.

It is worthwhile taking a step or two back from the latest progressive idea, folly, trend, or gimmick and reflect on the Hippocratic traditions of medicine, which of course predate the majority of the world’s great religions and its many forms of government.